Want a simple and easy-to-use EMR? Well, you can have it for free.

You may have heard of open-source software. When it comes to open-source, “free” has two meanings. First, you can download open-source programs at no cost. Second, “free” means freedom. The software is free in the sense that it belongs to you as much as it belongs to anyone else. If you download an open-source program, you can use it in any way you choose. You can use it forever as-is, you can modify it, or you can decide to update or not update. It’s your choice.

If the organization who makes the software shuts down or goes in a new direction that you don’t agree with, there’s nothing to worry about. What you have belongs to you. And, of course, the data in your system belongs to you as well. You don’t have to worry about big corporations “de-identifying” your data and selling it to the highest bidder. You don’t have to explain to a software vendor why you want to get your data out of their system and move it elsewhere.

The software I use is an open-source electronic medical records program called OpenEMR. I started using it in 2005. This program is one of the several open-source EMRs that are available. I especially like the commitment of the project to making it easily modifiable and extendable. It is relatively easy to add new features to the EMR and to improve existing features.

I personally love the flexibility. Over the years, I have taught myself how to modify the software. I have also developed some very useful plugin software to work within the system. The programming is fairly easy. Anyone can learn how to do it. Or, you have the option of hiring a programmer.

The thing I really like about my open-source EMR is that it makes my job easier, not harder. It streamlines the activities I need to do to better handle patient care. I am able to leverage stored data to generate prescriptions and orders easily. I can easily generate thorough progress notes. I am able to search and find useful information in seconds within my EMR instead of wasting time looking up the same things over and over again.

I like to use my EMR installed on a single computer. However, it’s easy to scale it up. I could easily run it over an office network or over the internet. It works for me as a single physician practice, but it would work just as well for 100 or more physicians.

I believe that the reason many doctors don’t seriously consider open-source medical software is because of the false sense of security that comes with buying from a large EMR vendor. We also find comfort in working for large employers who give us contracts, benefits, and job security. The rejection of free, open-source software by doctors reflects a deeper problem.

We, as doctors, are afraid of freedom. Many of us cannot conceive of the possibility of breaking away from the establishment. However, the establishment is psychologically destroying many of us. Commercial EMRs are part of the problem. Doctors spend hours of free time at home charting. While at work, they look at screens instead of patients. The overbearing software that is forced on many doctors is part of a system that continues to pile on more responsibilities. Doctors are treated like pack animals that can carry heavy burdens. If we let them, they will keep throwing more and more weight on our backs until we can’t take anymore.

Open-source software started as a revolution. Some very smart people decided to start a movement to make good software available to everyone with no strings attached. Today, open-source is everywhere. If you use an iPhone or Android phone, you are using open-source. If you use a Mac or Chromebook computer, you are again using open-source software. If you use Facebook, Amazon, Google or many other services on the internet, you are definitely using open-source.

So, open-source is everywhere. Even the military is using it. The Navy is using the Linux operating system to run its ships. This is the same operating system that runs Android phones.

I believe that it is time for open-source to find its way into medicine. We need freedom from money hungry vendors who stand over the near-dead carcass of the medical profession like vultures. We can take back ownership of the practice of medicine and still have the cutting edge software that we need to make our jobs easier.

Mark Leeds is a family physician and can be reached at his self-titled site, DrLeeds.com.

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Want a simple and easy-to-use EMR? Well, you can have it for free. 3 comments

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Markus

The EMR system in wide use in my community cost the hospital systems hundreds of millions of dollars. I always had the sense that it was designed by engineers who had a vision of some idealized version of medical practice and never sat down with a real doctor working with real patients to see the process that their program was supposed to capture. It was like a ski parka built by someone who had a faulty idea about human dimensions who never went out into the snow and jumped around. The one good thing was the connectivity to other providers, labs, imaging (the actual images), and pharmacies, a script went directly to the store. Does this DIY system have this connectivity? That would be a big deal for me. If the information never leaves my office, then a paper and ink entry chart works just fine.

The problem with that kind of connectivity is that the code required to connect to labs, pharmacies and diagnostic facilities may be proprietary. While a program like OpenEMR will not connect out of the box, there are vendors who can set up these connections if they are needed. I personally have not had a need for it.

It is true that programmers may implement good software design practices and still create a system that does not work in the real world. For example, it is considered good practice to normalize a database. This means reducing data redundancy. In writing a prescription, we find ourselves writing “mg” over and over again. This is because many medications are measured in milligrams. A computer scientist would see this as redundant and create a separate database field for units such as milligrams and micrograms. After fixing this “problem”, the database will relate the table of units to the table containing the prescription. A redundancy has been normalized. This goes on throughout the process of prescriptions, orders and progress notes. The problem is that to write a simple prescription, we find ourselves navigating multiple menus of options. It turns out that the normalization problem was only a problem for the computer scientist and not for the doctor. Optimizing software in this way can create hours of extra work for a busy doctor.

The best way to write medical software is to let doctors use it and listen to their complaints and fix it quickly in a tight feedback loop. This should be done during the early development stages until the software really works and makes the doctor’s work easier, not harder. In this process, it helps if the doctors make an effort to understand the programming process as well as the programmers making an effort to understand what doctors really need from their software.